Tobacco Control has morphed into a crusade intent on demonizing both tobacco users and the industry supplying them. This blog examines and comments on scientific issues surrounding tobacco policies - and fallacies.

Wednesday, May 24, 2017

Snus use is not associated
with pancreatic cancer, according to a study published in the International Journal of Cancer (abstract
here).
Researchers combined data from nine cohort studies that involved 400,000 men in
Sweden. Compared with never users, the
risk for current snus users, after adjustment for smoking, was 0.96 (95%
confidence interval = 0.83 – 1.11).

The new work was conducted by
the Swedish Collaboration on Health Effects of Snus Use, which includes
researchers from several Swedish universities.
(In the past, snus research was largely performed by the Karolinska
Institute, whose flawed studies I have previously documented here, here, here, and here.)Their
results are almost identical to those in a large study of smokeless use in North
America and Europe published six years ago (discussed here), and
to findings in another analysis published eight years ago (here).

Focus on a purported smokeless
tobacco-pancreatic cancer link began after publication of a cherry-picked
meta-analysis by Paolo Boffetta in 2008 (discussed here). Dr. Boffetta contradicted his own finding in
a later study (here), and
epidemiologist Peter Lee refuted it in his comprehensive analysis in 2009 (here). The fact is that there is no credible evidence
that American or Swedish smokeless tobacco is linked to pancreatic cancer.

Remarkably, the National
Cancer Institute persists in asserting a pancreatic cancer link in its
smokeless tobacco “fact sheet” (here). That document also asks what should be a
rhetorical question: “Is using smokeless tobacco less hazardous than smoking
cigarettes?”

The NCI’s answer is grossly misleading:
“all tobacco products are harmful and cause cancer…There is no safe level of
tobacco use.” The agency’s source for
this obfuscation is a 31-year-old Surgeon General report that has been eclipsed
by three decades of epidemiologic studies.

It should be noted that the
U.S. Food & Drug Administration is equally culpable. That agency used the bogus
smokeless-pancreatic cancer link as a talking point in last year’s $36 million
campaign against smokeless tobacco (here).

We already knew that moist
snuff and chewing tobacco have no measurable risk for mouth cancer (here). Now there is scientific evidence that smokeless
isn’t linked to pancreatic cancer.

Wednesday, May 17, 2017

“Current
public health policies offer smokers only two choices: to continue to smoke
despite knowledge of adverse health consequences, or to quit, which often
proves very difficult.

“In
a review of the avoidable causes of cancer, Doll and Peto observed that ‘No
single measure is known that would have as great an impact on the number of
deaths attributable to cancer as a reduction in the use of tobacco or a change
to the use of tobacco in a less dangerous way.’Unfortunately, the second part of this observation has not received
attention.Because smokeless tobacco
causes far fewer and considerably less serious health effects than does
smoking, it should be promulgated as an alternative to cigarettes for smokers unable
or unwilling to overcome their nicotine addiction.”

“Thus,
both the 35-year-old non-user of tobacco and the smokeless-tobacco user will
live on average to be 80.9 years of age compared with 73.1 years for the
smoker.Only 67% of smokers will be
alive at age 70, compared with more than 87% of smokeless-tobacco users and
nonusers of tobacco.

“…abstinence
is not the only approach to reducing tobacco-related mortality: for smokers
addicted to nicotine who would not otherwise stop, a permanent switch to
smokeless tobacco could be an acceptable alternative to quitting.”

“Among
these and many other opportunities, there’s probably no single intervention, or
product we’re likely to create in the near future that can have as profound an
impact on reducing illness and death from disease as our ability to increase
the rate of decline in smoking.

“We need to redouble efforts to help more
smokers become tobacco-free.And, we
need to have the science base to explore the potential to move current smokers
– unable or unwilling to quit – to less harmful products, if they can’t quit
altogether.”

Thursday, May 11, 2017

Comedian-cum-philosopher Stephen Colbert has opined, “Facts matter not at all.
Perception is everything.” Actual
British researchers have gone a step further, finding that, with e-cigarettes
and vaping, perception changes behavior.

British health authorities
have consistently told smokers the truth about vaping since 2011 (here, here, here and here), while
American officials, in their pursuit of a “tobacco-free society” or a “tobacco endgame,”
have emphasized the negative, or simply perpetuated untruths and urban myths.

Survey data in the U.K. and U.S.
demonstrate that truth-telling results in more accurate perceptions about
vaping than do obfuscation and scaremongering (here). Now, a survey from the U.K.’s Action on
Smoking and Health (ASH) (here) shows
that favorable perception translates into positive behavior.

In this case, facts do
matter. The U.K. vaping population has
ballooned, from 700,000 in 2012, to 2.9 million this year. Importantly, the majority (52%) are former
smokers – a sharp contrast to American data showing that most vapers are
current smokers (here).

Within these encouraging U.K.
figures are reasons for concern. First,
the prevalence of vaping is currently 5.8%, which is only a 12% increase since
2015. This suggests that e-cigarette use
may be leveling out. With some nine
million Brits smoking today (here), vaping
momentum will have to grow in order to drive down smoking.

A major barrier to the
success of e-cigarettes is misinformation (here). The ASH report documents that 22% of smokers
believe that e-cigarettes are more or equally harmful than cigarettes – a 9%
increase from four years ago. Anti-vaping
propaganda, discussed here, may be
a contributing factor. Interestingly,
16% of smokers who tried but don’t use e-cigs said they would try them again if
they were sure they were safe to use.

The ASH report also documents
that e-cigs don’t work for all smokers.
Of smokers who tried but no longer use e-cigarettes, 25% said the
devices didn’t feel like smoking, and 20% said they didn’t help with cravings. Smokers should be given access to a range of
safer smoke-free substitutes, including smokeless tobacco and heat-not-burn
products, in order to help them quit their deadly smoking habit.

My Credentials

I am a Professor of Medicine at the University of Louisville, I hold an endowed chair in tobacco harm reduction research, and I am a member of the James Graham Brown Cancer Center at U of L.

For the past 20 years I have been involved in research and policy development regarding tobacco harm reduction (THR). THR advocates acknowledge that there are millions of smokers who are unable or unwilling to quit with conventional cessation methods involving tobacco and nicotine abstinence, and we encourage them to use cigarette substitutes that are far safer.

My research has appeared in a broad range of medical and scientific journals. I have authored commentaries in the general press and I wrote the book, For Smokers Only: How Smokeless Tobacco Can Save Your Life. In 2003 I served as an expert witness at a Congressional hearing on tobacco harm reduction, and I have spoken at numerous international forums, including one held in London at the British Houses of Parliament.

My research is supported by unrestricted grants from tobacco manufacturers to the University of Louisville and by the Kentucky Research Challenge Trust Fund.